Preoperative Shoulder Injections Are Associated With Increased Risk of Revision Rotator Cuff Repair

Preoperative Shoulder Corticosteroid Injection Is Associated With Revision After Primary Rotator Cuff Repair

“…Also in this issue, Weber, Trasolini, Mayer, Essilfie, Vangsness, Gamradt, Tibone, and Kang 8 report that injections prior to RCR are associated with increased rotator cuff revision rates based on an analysis of 22,156 included patients. Weber et al, in agreement with Traven et al, 3 report a correlation between preoperative shoulder injections and revision RCR. Moreover, Weber et al report not only time dependence but also a dependence on frequency, "with [both] more frequent injections and injections closer to the time of surgery.associated with higher revision rates."…”

“…The cited studies and commentary are nuanced; readers who perform shoulder steroid injections should read these articles in detail to best advise their patients. In the end, according to Traven et al, 3 "consideration should be given to minimizing preoperative injections in patients requiring RCR or delaying primary rotator cuff repair for 6 months following injection. "…”

Editorial Commentary: Steroid Injections Prior to Arthroscopic Rotator Cuff Repair—Is It Time to Rethink a Conservative Treatment Paradigm?

“…In a recent study, Maman et al 5 showed even a single steroid injection could significantly weaken rotator cuff tissue in a rat model and negatively affect bone quality in addition to causing deterioration of the osteotendinous junction. Traven et al 4 cited evidence of this in other published rat studies. Conversely, negative effects of steroid injections on human rotator cuff integrity have been refuted.…”

“…Prior research has shown the negative impact smoking has on rotator cuff healing, and recent studies have strengthened the link between smoking and repair failure. 11,12 With an odds ratio indicating a 2.5 times greater risk of repeated surgery for smokers compared with nonsmokers, the study by Traven et al 4 adds to the body of data supporting tobacco abuse counseling and even postponement of surgery until the patient has ceased use of tobacco products.…”

“…It would follow that delaying repair while the patient responds to steroid injections may be delaying the best treatment option in some instances, particularly if a trial of nonsteroidal agents and physiotherapy has already failed to improve function and reduce pain. Another important factor in the study by Traven et al 4 is that the mean patient age was around 50 years, so applying their findings to clinical practice might also favor a more aggressive approach with earlier surgery to optimize the potential for successful repair compared with the treatment approach in an older patient population.…”